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Original Investigation
December 9/23, 2002

Body Mass Index and the Risk of Stroke in Men

Author Affiliations

From the Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital, (Drs Kurth, Gaziano, Berger, Rexrode, Cook, Buring, and Manson), and Department of Ambulatory Care and Prevention (Dr Buring), Harvard Medical School; Department of Neurology, Boston University School of Medicine (Dr Kase), Department of Epidemiology, Harvard School of Public Health (Drs Kurth, Manson, and Buring), and Massachusetts Veterans Epidemiology Research and Information Center, Boston VA Healthcare System (Dr Gaziano), Boston, Mass; and the Institute of Epidemiology and Social Medicine, University of Muenster, Muenster, Germany (Dr Berger).

Arch Intern Med. 2002;162(22):2557-2562. doi:10.1001/archinte.162.22.2557

Background  Although obesity is an established risk factor for coronary heart disease, its role as a risk factor for stroke remains controversial.

Methods  Prospective cohort study among 21 414 US male physicians participating in the Physicians' Health Study. Incidence of total, ischemic, and hemorrhagic stroke was measured by self-report and confirmed by medical record review. We used Cox proportional hazards models to evaluate the association of body mass index (BMI), calculated as self-reported weight in kilograms divided by the square of the height in meters, with risk of total, ischemic, and hemorrhagic stroke.

Results  During 12.5 years of follow-up, 747 strokes (631 ischemic, 104 hemorrhagic, and 12 undefined) occurred. Compared with participants with BMIs less than 23, those with BMIs of 30 or greater had an adjusted relative risk of 2.00 (95% confidence interval [CI], 1.48-2.71) for total stroke, 1.95 (95% CI, 1.39-2.72) for ischemic stroke, and 2.25 (95% CI, 1.01-5.01) for hemorrhagic stroke. When BMI was evaluated as a continuous variable, each unit increase of BMI was associated with a significant 6% increase in the adjusted relative risks of total (95% CI, 4%-8%), ischemic (95% CI, 3%-8%), and hemorrhagic stroke (95% CI, 1%-12%). Additional adjustment for hypertension, diabetes mellitus, and hypercholesterolemia slightly attenuated the risks for total and ischemic (relative risk, 4%; 95% CI, 2%-7%), but not hemorrhagic, stroke.

Conclusions  These prospective data indicate a significant increase in the relative risk of total stroke and its 2 major subtypes with each unit increase of BMI that is independent of the effects of hypertension, diabetes, and cholesterol. Because BMI is a modifiable risk factor, the prevention of stroke may be another benefit associated with preventing obesity in adults.